Thursday, January 31, 2008

No, it's not another report card scheme like the one I reported on a few weeks ago. Now, the Qualifications and Curriculum Authority of England has awarded McDonald's restaurants the right to award the equivalent of an advanced high-school qualification as part of a governmental push to build skills in English youth.

Apparently McDonald's will train "students" in "basic staff management" and in their course work,

"cover everything the 7,000 managers of McDonald’s outlets across the country need to know for the day-to-day running of a McDonald's restaurant; from basic operational requirements to finance, marketing and HR."

Currently in England there are over 1,000 McDonald's restaurants.

Currently in England one in six 11 and 12 year olds is obese as are 1/4 of adults and as recently as two days ago experts in England predicted that obesity will soon be the number one cause of preventable death in their country.

Last week in England it was announced that 372 million pounds were being put aside to combat obesity.

Hmmmmmm, so let me get this straight England. Your country thinks obesity is about to become its number one preventable cause of death, your kids and adults are obese, there are tons of fast food restaurants all over and you've just pledged almost 400 million pounds to work on obesity treatment and prevention and yet you've also gone ahead and officially encouraged your country's obese youth to learn how to open more fast food franchises?

If you're already outraged, then I believe it's time for you to write.

First you can write to the Heart and Stroke Foundation - to the bosses and also to the people directly responsible for the Health Check criteria.

Who's responsible?

Well, I had mentioned in a prior post that on the Health Check's website there's reference to an expert technical advisory committee that established and oversee the Health Check criteria. I had also mentioned that the names of those experts were nowhere to be found on the site and that it seemed odd to me that they weren't there. Well, thanks to a kind reader, I've got the names of Health Check's Technical Advisory Committee as of January 2006.[UPDATE: January 30th, 2008 the Health Check website posted the names of the current advisory committee]

They are:

Bretta Maloff, RD: She was the person interviewed by the CBC on the Marketplace expose, and is the chair of Health Check's technical advisory committee. She's been at Health Check from the very beginning having helped set the original Health Check nutritional criteria.

Fran Berkoff, RD: She wrote the book, "Foods that Harm, Foods that Heal".

Chantal Blais, RD: She's the head of Clinical Nutrition Service at the Clinical Research Institute of Montreal.

Allison M. Stephen, PhD: She's the head of nutritional epidemiology at the Medical Research Council's Human Nutrition Research in England.

Laurie Wadsworth PhD: She's an assistant professor in the Department of Human Nutrition at St. Francis Xavier University in Antigonish.

Bernard LeBlanc, BSc: According to the Health Check website (at least as of January 30th, 2008) he's "self- employed as a consultant to the food industry."

So those seven folks presumably are in fact the dietitians (and the food industry consultant) that go shopping with you every time you buy Health Check'ed products.

Do you think they've done a great job? Have they helped you and your families make "healthier" choices?

Feel free to drop them a line. Click here to send them an email, and included on the email will be Sally Brown (CEO of the Heart and Stroke Foundation), Stephen Samis (Scientific Director of the Heart and Stroke Foundation), and Terry Dean (General Manager of Health Check)

You can also write your MP and let them know that you'd be quite unhappy were the government to adopt the Health Check as our official, national, front of package labeling program. If you don't know who your MP is, click here and using your postal code, you'll find out not only who it is, but also their email address.

You can also spread the word. Link to this post, email it to friends, Stumble it, Digg it, Facebook it, whatever - if you're concerned, please help spread awareness.

Lastly, if you're the Heart and Stroke Foundation (and I know that they do indeed read my blog) you can actually make real changes. Martin Luther King Jr. once said,

"It's always the right time to do the right thing"

Here's a wonderful opportunity for you to in fact do the right thing and in so doing, regain some of the trust you've lost through Health Check. I promise, were there real and evidence-based changes made, I would certainly be among the first to stand up and applaud.

(Unfortunately, I'm missing email addresses for: Sharyn Joliat and Bernard LeBlanc - if anyone out there has them, please email me with them and don't worry, I protect my sources).

[Hat trip to Adrian, a medical student at the University of Ottawa who during a rotation through my clinic dropped the bombshell that Health Check'ed Slush Puppies were in fact being sold at the Ottawa General Hospital and then was kind enough to snap me a picture]

Friday, January 25, 2008

Thanks to those who posted comments this past week - it's always great to see discussion.

So now I'm going to play corporate shill for Funny Fridays - except I don't get paid by the corporation I'm shilling.

I'm actually not shilling for the corporation either, just their brilliant advertising which saw this campaign go viral over the internet.

It's Burger King's Whopper Freakout and all I'll say is that it's quite an interesting societal statement when being told that you can't have a Whopper generates the same type of reaction you might expect from having your spouse tell you they slept with your sibling.

Now before the brilliant advertising has you rushing out to Burger King, please be aware that each Whopper with cheese has 760 Calories, 47 grams of fat (16 grams saturated, 1.5 grams trans) and 1,450mg of sodium. Translation - it's not even Health Check'able.

Thursday, January 24, 2008

In the Canadian Press article that detailed some of my concerns with Health Check, Terry Dean chose to attack me and reported that my focus and my clinic's focus is, "very much on diet".

Of course, that's not even remotely true given that my office's staff includes physicians, registered dietitians, personal fitness trainers (with on-site facilities) and a clinical psychologist and that we actually don't have any particular diet that we espouse, nor any food that we forbid.

We do however, teach our patients a great deal about nutrition.

I think it's quite telling that rather than respond to my concerns the Heart and Stroke Foundation chose to question the messenger.

Telling, but not particularly surprising, given that their recommendations are quite indefensible as evidenced by their efforts to defend them last night on CBC's investigative journalism program Marketplace.

According to Terry Dean, Health Check's approach,

"is more of a comprehensive view that it's a public health model. It's not a sodium reduction problem, it's not a diet program, it's not a fat reduction program. Our program is based on the overall diet and general healthy eating recommendations."

and in the Ottawa Citizen article that came out the following day Mr. Dean, while admitting sugar and sodium levels were sub-optimal went on record to state that while perhaps suboptimal in one nutrient,

"In every case, there are two or three nutrients it has to have"

Two or three whole nutrients. You don't say.

So the question I've got for you today - do you think that a "comprehensive" approach to nutrition would only involve looking at 2-3 nutrients?

Looking at the Health Check criteria, here is a list of every thing Health Check considers in evaluating a product (and bear in mind, according to Terry only 2-3 things are considered per product):

Fat

Fibre

Sodium

Sugar

Vitamin A

Vitamin C

Calcium

Iron

Folate

That's it, that's all.

So does Terry Dean really think that there are only 9 things worth considering when evaluating the nutritional value of a food? Nope, not if he agrees with his Health Check program he doesn't, because if he agrees with his Health Check criteria, he believes that there in fact are not 9 things worth evaluating per food item, he believe that there are only 3 or 4 things worth considering. If he believes in the "comprehensive" approach of Health Check he would therefore also believe that foods should be considered in if, then rule form whereby for example if a slice of bread has less than 480mg of sodium, is a source of fibre, and is low in fat and trans fat it's good with the Health Check folks irregardless of whether or not the grain is refined or how much sugar might have been added.

Contrast Health Check's 9 nutrient if then rules with the list of nutrients and nutritional concepts recently woven together by 14 of the world's experts in nutrition into a complex food rating algorithm known as ONQI and also featured on last night's program:

Fiber

Folate

Vitamin A

Vitamin C

Vitamin D

Vitamin E

Vitamin B12

Vitamin B6

Potassium

Calcium

Zinc

Omega 3 fatty acids

Bioflavanoids

Carotenoids

Magnesium

Iron

Saturated fat

Trans fat

Sodium

Sugar

Cholesterol

Fat quality

Protein quality

Energy density

Glycemic load

Oh, and they apply all 25 criteria to every single food they rate.

Yup Terry, ensuring every food has "2 or 3 nutrients" is super comprehensive. Great job.

You know the Hindenburg looked great from afar as well.

[If you missed last night's show, CBC has it up on their website here.]

Terry Dean, General Manager of Health Check from an article published last Saturday in the Ottawa Citizen, apparently agreed that some Health Check products may have a sugar or sodium content that is higher than optimal.

He also reported both to the Canadian Press and the Ottawa Citizen that Health Check was:

A. Not a diet programB. Not a sodium reduction programC. Not a fat reduction program

Ok, so let me get this straight.

According to the General Manager of Health Check, if you choose foods using the Health Check, that won't help you reduce your weight, won't help you reduce your sodium, won't help you reduce your fat and will possibly provide you with products that have admittedly higher than recommended amounts of sugar and sodium.

Fantastic?

So what is Health Check good for again?

Oh yeah, it generates close to $3,000,000 in annual revenue for the Heart and Stroke Foundation.

I wonder if changing their criteria making them more stringent and actually evidence-based would limit the number of companies and products to which they could sell their logo?

Do you think that would affect their revenue?

Stay tuned tomorrow for an exploration of ALL of the criteria used by Health Check (don't worry, there are only 9 so it won't be that long of a post).

Tuesday, January 22, 2008

Let's go back to that press release from the Beef Information Centre where Heart and Stroke Foundation Registered Dietitian Carol Dombrow tells us that lean ground beef is a healthy choice,

"With ground beef burgers being one of the most popular meats in the summer months, having the Health Check symbol in place now helps consumers understand that lean and extra lean ground beef can be part of a healthy diet."

Now for the sake of today, let's pretend that we don't know that beef consumption increases our risk of cancer and therefore let's ignore the argument that regardless of "lean-ness", beef is a food we should limit.

Today I'd like to talk about fat.

Now I'm not personally, terrifically scared of saturated fat. Trans I avoid and unsaturated I maximize but saturated, the stuff of beef, I simply try to minimize.

Health Canada on the other hand, really doesn't like fat and it puts a blanket limitation on its consumption at 30% of your total daily calories and since the Heart and Stroke Foundation reports that it models its Health Check program off of Health Canada's recommendations, therefore they too recommend that you limit fat to 30% of your total daily calories.

The Heart and Stroke Foundation adds additional caveats to fat consumption in the directives we saw yesterday, "

"Look for a lower (10% or less) % Daily Value for fat, saturated and trans fat, cholesterol and sodium."

and

"Get less of these nutrients: Look for a lower % Daily Value (10% or less) for nutrients such as fat, saturated and trans fat and sodium"

So that seems pretty clear. Health Canada says that we should get less than 30% of total daily calories from fat and the Heart and Stroke adds that we should avoid foods containing more than 10% of our total daily fat value.

Now back to lean beef (and sorry, some math too).

Following the Food Guide and eating Health Check'ed lean beef women can have 150 grams a day and men, 225 grams a day.

Lean beef by definition is 17% fat (extra lean is 10%).

17% of women's 150 grams = 25.5 grams of fat.

17% of men's 225 grams = 38.25 grams of fat.

There are 9 calories per gram of fat.

25.5 grams of fat = 229.5 calories.

38.25 grams of fat = 344.25 calories.

Health Canada, as evidenced by our food labels, believes the average adult needs 2,000 calories daily (though that's likely too much for the average woman and too little for the average man).

If only 30% of our daily calories are supposed to come from fat, 30% of 2,000 calories would mean that Health Canada recommends that we get no more than 600 calories from fat daily.

So in case you didn't follow all of that the end result is that if you choose the Health Check'ed lean ground beef that Heart and Stroke Dietitian Carol Dombrow says can be part of your healthy diet and you actually restrict your portion to those recommended by the Food Guide (and let me tell you, that's not a ton of meat), then in that single serving if you're a woman you'll be consuming 38% of your total daily recommended intake of fat and if you're a man 57%, this despite the fact that the Heart and Stroke Foundation also recommends that you avoid choosing any item containing more than 10% of your total dietary fat daily value.

So I've got a few questions here.

Firstly the obvious one, can I have some of what the folks over at the Heart and Stroke Foundation's Health Check are smoking because their world certainly seems much kinder and gentler than mine.

Secondly though, and this one's glaring. Even putting aside all of these astronomical numbers, can you explain to me why the Heart and Stroke Foundation has agreed to lend its good name to lean ground beef when extra-lean ground beef, with 41% less fat than lean ground beef, is readily available?

It make me wonder if that Marvel Comics bizarro code, "Us do opposite of all earthly things" is posted outside the Health Check offices.

[Though you should know, run those same equations with even extra-lean ground beef and the Heart and Stroke Foundation would still be giving its blessing for women to consume 22% of their total daily fat intake and men 33% from a single, approved, Health Check'ed portion, despite at the same time recommending not consuming more than 10% from any one choice]

UPDATE July 24th, 2009: Health Check recently revamped their website and they've removed the PDF in question. Now the only guidance they provide is to choose items "lower" in %DV.

I've got nothing to criticize from their directions and would like to pull one of their directives out for my readers,

"Look for a lower (10% or less) % Daily Value for fat, saturated and trans fat, cholesterol and sodium."

Pretty good advice.

So good in fact, they've repeated it and published it in their October 2007 Healthwise newsletter where one of the Heart and Stroke Foundation's Registered Dietitians Alyssa Rolnick wrote a piece entitled, "Judge a food by its label". She provides a four step program to employ when reading food labels. Here's step 3,

"Step 3 Get less of these nutrients: Look for a lower % Daily Value (10% or less) for nutrients such as fat, saturated and trans fat and sodium."

UPDATE July 23rd, 2009: They removed this too.

So that sounds pretty clear. If an item contains more than 10% the daily value of sodium, the Heart and Stroke Foundation thinks you should avoid it, right?

Apparently not.

I created some tables to illustrate what I mean.

The tables were created by taking the Health Check criteria and plotting the allowable limits per item on sodium vs. what that would mean in percent daily value looking at both the current 2300mg recommendation and the 1500mg recommendation (coming from the National Sodium Policy Statement that the Heart and Stroke Foundation signed).

Let's have a peek:

Grocery Store Food Item

Health Check

%DV

%DV

Allowable

Sodium

Sodium

Sodium

2300mg

1500mg

ALL GRAIN PRODUCTS

480 mg

21%

32%

Canned Vegetables

480 mg

21%

32%

Frozen Vegetables

480 mg

21%

32%

ALL MILK PRODUCTS

480 mg

21%

32%

ALL MEAT PRODUCTS

480 mg

21%

32%

Store Pizza

480 mg

21%

32%

Veggie or Meat Pies

480 mg

21%

32%

Main Entrée Sauce

480 mg

21%

32%

Potato Salad

480 mg

21%

32%

Other Salad

480 mg

21%

32%

Tomato Juice

650 mg

28%

43%

Vegetable Juice

650 mg

28%

43%

Soups

650 mg

28%

43%

Store Dinner Entrees

720 mg

31%

48%

Store Mixed Dishes

720 mg

31%

48%

Yes, you're reading the table correctly. Not one item, not a single one, has criteria that would limit sodium to less than 10% of your total daily value - thereby allowing the food industry to happily market foods that can contain between 21% and 48% of your total daily recommended sodium intake as healthy, nutritious and approved by the Heart and Stroke Foundation.

But wait, it gets worse.

What about restaurants?

Restaurant Food Item

Health Check

%DV

%DV

Allowable

Sodium

Sodium

Sodium

2300mg

1500mg

Side Salad

480 mg

21%

32%

Appetizer

480 mg

21%

32%

Soups

650 mg

28%

43%

"Small" Entrée

960 mg

42%

64%

Pizza

960 mg

42%

64%

Large Entrée

1,300 mg

57%

87%

Again here, not one single item is limited by the Health Check criteria so as to provide no more than 10% of the daily value of sodium and now restaurants can market foods that can contain between 21% and 87% of your total daily recommended sodium intake as healthy, nutritious and approved by the Heart and Stroke Foundation - that's 87% of the National Sodium Policy Statement's daily sodium recommendation in a single Health Check'ed food item.

If any of the readers out there have Alyssa Rolnick's email, I'd love to send her a copy of these tables and ask her for her thoughts. Clearly either her recommendation to avoid foods containing greater than 10% of total daily sodium values was wrong, or she must agree that the Health Check sodium criteria are woefully deficient. Either way, I'd love to hear her explanation.

Friday, January 18, 2008

If you click on the image above you'll see a screen capture of Health Check's nutrient criteria page for groceries. The column where I've highlighted cookies is their grain column and yes indeed, if you look carefully at the screen capture up there they also for reasons beyond me, consider potatoes a grain (last I checked they were a starchy tuber).

But let's get back to the cookies.

In what alternate universe would cookies qualify as a grain choice?

Interesting thing about cookies, Health Check and Canada's Food Guide. You see the Heart and Stroke Foundation are now on record stating that my concerns with Health Check are because I don't like Canada's Food Guide (published yesterday in the Canadian Medical Association Journal). And it's true, I don't like Canada's Food Guide, yet here's a statement that may shock you coming from me,

Canada's Food Guide does a far better job than Health Check's criteria at steering people to healthier choices.

Here's what the Food Guide has to say about cookies and a few other tidbits,

So not only does the Food Guide not think that cookies are grains, it recommends that they be limited. It also recommends that muffins, granola bars, ice cream, french fries, fruit flavoured drinks and sweetened hot or cold drinks be limited.

The Heart and Stroke Foundation?

They use their Health Check logo to deceive Canadians into thinking that muffins, cookies, ice cream, french fries, granola bars, slush puppies and sugar sweetened milk are not only choices that shouldn't be limited but rather choices that are

"'nutritious', 'healthy', 'good for you' or 'approved by the Heart and Stroke Foundation.'"

So again I've got to point out, if shopping with the Health Check is like shopping with the Heart and Stroke Foundation's dietitians, and if the Heart and Stroke Foundation's dietitians think cookies and potatoes are grains, that french fries, sugar sweetened milk and slush puppies are healthy, don't you think it's time for them to hire some new dietitians?

Oh and Heart and Stroke Foundation, please stop hiding behind the Food Guide because the fact is you don't even manage to follow the Food Guide's albeit meager nutritional recommendations.

Regular readers, this is indeed Funny Friday. It's one of those schadenfreude ones where cookies have magically become grains.

What a train wreck.

Have a great weekend.

UPDATE: July 23rd, 2009. In their newest (July 09) criteria Health Check has finally realized that cookies and potato chips aren't healthy! They've removed them from the health check program!

Thursday, January 17, 2008

Sugars (different types) are the 2nd, 3rd, 5th, 6th and 7th ingredients (they total about 4 teaspoons) and make up slightly less than 50% of carbohydrates.

190 Calories.

Source of fibre.

Only 180mg of sodium.

Low saturated fat.

Zero trans fats.

Hopefully readers of my blog know that my post title question is rhetorical.

Putting whole grains into a pop tart doesn't make it healthy, it makes it just slightly less unhealthy than a regular pop tart.

Of course if I were Kellogg's I'd shrink the size of my bar by 20 percent, call them Pop Tart Breakfast Bars and apply for a Health Check because this product, aside from it's size, meets all of the new Health Check criteria for filled or coated grain-based bars.

Wednesday, January 16, 2008

So almost a full year after the release of the new Canada's Food Guide the Heart and Stroke Foundation's Health Check has finally figured out what revisions it wants made to their incredibly poor, 16 year old, criteria.

Perhaps tellingly the revisions were released without fanfare or press release on their website this past Friday (UPDATE July 23rd, 2009: They removed the press release from their website) and despite noting,

"Health Check's Technical Advisory Committee, made up of dietitians and nutritional experts from across the country, have developed and recommended these changes."

a list of said dietitians and experts is nowhere to be found (Though I can't say I blame them, I wouldn't want my name attached to this mess either)

So what exactly did they change?

Not much.

Restaurant criteria stayed exactly the same.

Supermarket criteria had 6 minor adjustments:

1. Trans-fats can now only make up 5% of an item's total fat content.

[Contrast that weak limitation to these statements that the Heart and Stroke Foundation's own CEO Sally Brown made last year,

"Trans fats are a "toxic" killer that need to be removed from the food chain as soon as possible"

They've still pretty much ignored sodium so for example pieces of bread, beverages or soups with 1/3 of your total recommended sodium intake are still just dandy with them.

They've recommended a small reduction in added sugar to a very small percentage of their categories and still ignore the fact that juice is simply a glass of sugar with a few nutrients, and with no limitations on its consumption thereby also ignore the recommendations of the world's experts in childhood obesity.

They haven't touched their restaurant criteria thereby they still allow for restaurants to push salt at you in total day's worth quantities in single, Health Checked meals.

They haven't put any limits on red meat consumption despite its clear cut link with cancer and the limitations recommended by the World Cancer Research Fund and the world's experts in nutrition including Harvard's Walt Willett.

They haven't made any distinction between whole grain consumption and refined and are therefore happy selling you products that are entirely refined (this despite the new Food Guide's weak but perhaps better than nothing recommendation we make at least half of our grains whole) thereby allowing you to, with their explicit blessing, increase your risk of developing type II diabetes.

They haven't stopped endorsing junk food as healthy choices thereby continuing to lull consumers into thinking that perhaps serving their children Health Check'ed cookies, muffins or french fries are just as good and healthy as fruit and vegetables (interestingly again here even our Food Guide recommends we limit the sweet stuff and certainly unlike the Heart and Stroke Foundation doesn't suggest in any way shape or form that cookies are healthy).

They haven't banned the use of cartoon characters to peddle their foods to children - a practice universally maligned among responsible children's and nutritional advocates.

Monday, January 14, 2008

Dozens of Americans meet at a ranch vying for half a million dollars during a weight loss contest.

The first 4 months they spend working out on the ranch all day long under the supervision of trainers and eating prepared low calorie meals.

Contestants compete in the requisite competitions, many of which involve the ridiculous "food temptations", but most of which involve feats of physical strength or endurance.

After 4 months on the ranch the remaining folks (people get voted off each week) go home and spend I believe an additional 6 months trying to lose weight on their own until finally they all return and get weighed and the person who lost the most weight (as a percentage of their initial weight) wins.

Perhaps the most dramatic part of the show are the weekly weigh ins on the incredibly over-sized scale that builds suspense by displaying the contestants' weights bouncing around for some time before finally displaying how much they've lost that week.

Weigh-in wise, week after week the numbers are dramatically fluctuant with some weeks folks losing more than 5% of the previous week's weight and others, virtually nothing. Those variations are simply a reflection of different degrees of hydration and they don't really interest me - what interests me is the fact that consistently, season after season, some people simply lose faster than others with a cadre of contestants usually losing weight twice as fast as another cadre of slower losers.

So the fast losers - do you think they're eating half as much and working out twice as hard? Do they have double the "willpower" of the people who simply don't lose quicker? Are they twice as motivated?

Of course not - as is clearly evidenced by the television show, everyone on that ranch is busting their butts exercising and eating low calorie meals as they all have the added motivational benefits of unlimited time and resources, millions of national viewers and let's not forget the $250,000 carrot dangling in front of them.

So what's the difference?

Genetics.

Weight loss is not simply a one to one relationship between how many calories you eat and how many calories you burn. The body's a big black box with food going in the top and coming out the bottom but in between there are dramatic between person differences in how calories are handled. The result of course- some people lose weight far easier than others.

My conclusion therefore?

The show's all about genes.

Oh, and there are two winners on the show by the way. There's the "Biggest Loser" from the folks who don't get voted off earlier on and then there's the person from the folks who were voted off who loses the most.

The two winners from last year?

Identical twins.

UPDATE: A reader pointed out that in fact the contestants cook for themselves on the ranch - certainly this would allow for more variability, but still not enough to account for such wide divergences in weight loss.

Saturday, January 12, 2008

This coming Friday (January 18th), I've been asked to speak at the Women's Health Matters Forum and Expo being held at the Metro Toronto Convention Centre and being put on by Toronto's Women's College Hospital.

Thursday, January 10, 2008

Yesterday Samara Felesky Hunt, registered dietitian and former Director of the College of Dietitians, wrote a column in the Calgary Herald talking about dieting and weight loss.

In one breath she states,

"Following the guide will help meet your needs for vitamins, minerals and other nutrients, but also assist in weight loss."

But it was her next few breaths that I found revealing,

"For weight loss, focus each day on eating at least four servings of vegetables and at least three fruits. Eat whole grain carbohydrates and limit them to four to six servings for women and five to seven servings for men."

So really what she's doing is instructing her readers that if they want to lose weight they should in fact not follow the Food Guide.

She instructs women to consume up to 33% less grains than recommended by the Guide and men up to 40% less. She also qualifies which type of grain and does what the Food Guide does not - she recommends the exclusive consumption of whole grains.

Gee, wouldn't eating markedly less food than the Food Guide recommends suggest that actually following the Food Guide would not cause weight loss? Wouldn't it also suggest that in fact actually following the Food Guide would therefore likely lead to weight gain?

Lastly, if the Food Guide is such an evidence-based vehicle, why is it that this registered dietitian is qualifying its grain recommendations to steer folks directly and exclusively to whole grains when the Food Guide only steers you to make half your grains whole?

Wednesday, January 09, 2008

Do you work for the Canadian Government? If you do, perhaps you'd like to call your HR department and ask them why it is that the federal government's health care insurance plans don't cover the services of a registered dietitian and while I can't speak for all provinces, neither does the plan for the Province of Ontario's government workers.

That sure seems a bit incongruent doesn't it?

After all, we know that the government worked closely with the Dietitians of Canada in the creation of the Food Guide and putting aside my various condemnations of the Guide's non-evidence based recommendations, doesn't it strike you as odd that while the government might feel dietitians are valuable contributors to counsel Health Canada on nutrition that they don't insist their insurers pay for individual dietetic consultations for their employees?

It's also odd given that the Canadian Government is well aware of the perils of obesity and the role of a healthy diet in the prevention of chronic disease.

David Butler Jones, Canada's Chief Public Health Officer has been heard to state that,

"with the rapid increase in obesity in young people, that this generation currently in childhood will be the first ever to experience poorer health than their parents"

and that,

"by increasing their levels of physical activity, improving eating habits and achieving healthy weights, Canadians can help ensure good health and prevent many chronic diseases, including some cancers, type 2 diabetes, cardiovascular disease and stroke."

"More than ever, Canadians understand the consequences of an unhealthy diet. We know that a bad diet and no exercise can lead to serious conditions such as obesity, diabetes, heart disease, and certain types of cancer."

And it's not as if the government's insurance plan doesn't cover complementary health care and paramedical services. Both the federal and the province of Ontario's plans cover psychologists, optometrists, chiropractors, chiropodists, audiologists and naturopaths. I'm told they even shell out for homeopathic consultations, a highly contentious practice desperately lacking in evidence-based results covered elegantly in the Guardian by Dr. Ben Goldacre and with mirth yesterday regarding its use in obesity treatment by Dr. J. on Calorie Lab.

If you'd like to complain to Tony Clement feel free to click on his name to send his office an email.

If you're looking to email David Butler-Jones, while according to his website the Chief Public Health Officer "welcomes your comments and suggestions", his office's website doesn't provide an email address to which to address them. Instead they provide a fill in the blank form to fill out and Dr. Butler-Jones' snail mail contacts. I was however able to find his phone number in the Government directory and so if you'd like to call him to discuss this just buzz (613)954-8524 or fax him at(613)954-8529.

If you work for the Canadian government, please share this post with your colleagues.

Anyone out there up for a petition?

UPDATE: A kind reader has forwarded Dr. Butler-Jones' email. Click his name if you'd like to share your thoughts.

UPDATE 2: Another kind reader has informed me that really the person in charge of these type of decisions is Mr. Vic Toews from the Treasure Board. If you'd like to email Vic Toews simply click his name.

Tuesday, January 08, 2008

Starbucks has gone and created a fancy coffee that's not the caloric equivalent of a quarter-pounder.

It's called the "Skinny Latte" and it's made with skim milk and sugar-free syrup. They come in multiple flavours including cinnamon dolce, mocha, vanilla, hazelnut and caramel.

A tall version of any will run you about 90 calories.

Nice to have a lower calorie fancy option.

[Interesting side note:

CalorieLab reported on a Starbucks blog where a barista complained about the use of the term "skinny" and how she felt it was a politically incorrect term to use as it might be upsetting to folks who work at Starbucks who aren't skinny.

I wonder if she also worries about the use of the Starbucks cup-size terms short and tall?]

Monday, January 07, 2008

Some of my longer term readers may remember a post from a while back that contrasted the messages of the Heart and Stroke Foundation's CEO and Chairperson of Canada's trans-fat task force Sally Brown taken from before and after Tony Clement announced that our government was not going to adopt the task force's consensus recommendation to regulate trans-fats in our food supply in place of a please, pretty please wait and see gift to the food industry.

Well that hypocrisy continued a few weeks ago when the first "report card" came in. Sally Brown had this to say in the Heart and Stroke Foundation's press release on the report,

"Many companies have made significant progress in reducing trans fats, which we applaud, but other companies do not seem to be getting the message."

"At the end of the day, this first report on trans fat is mixed".

Clearly this shouldn't have been a surprise to her as prior to the official government stance she had been quoted as saying,

"if you don't regulate it, it'll be piecemeal"

A point not lost on MP Judy Wasylycia-Leis who a few weeks ago in a meeting of the Standing Committee on Health stated,

"That's my point. The task force said to put in place your regulations so that by June 2008 industry must be in compliance. You are now letting them off the hook until the spring of 2009; then you're going to assess, and then you're going to see if mandatory.... Look at how much time is wasted, when you have the facts, you have the correlation, and you know what works.

Who got to you? Why the delay? It's not industry. Who got to you, or the minister? What happened?"

I'd love to pose those same questions to Sally Brown and also to Stephen Samis, the Director of Health Policy for the Heart and Stroke Foundation who in this CBC video from April 2007 clearly made the case for a regulated approach:

If anyone knows where the Sally Brown from before has gone perhaps you could discuss her own quotes with her, more specifically the quotes she gave before she decided that along with the government the Heart and Stroke Foundation would apparently prefer to sit idly by while the industry enjoys their 2 year get out of jail free card.

"Taking all the evidence into consideration, the task force agreed to a regulatory approach to effectively eliminate transfer in all processed foods"

"The problem is, without regulations, we won't get everyone on board and it's harder to get product changes. Unlike french fries, with something like doughnuts and chocolate bars, you have to take it out of the formulation which is more difficult. We needed regulations uniform across both sectors"

"Trans fats are a "toxic" killer that need to be removed from the food chain as soon as possible"

"We know that the government is taking our recommendations very seriously, but we also know that they're getting some push back from industry who traditionally don't like regulatory approaches"

"Our argument is, if you don't regulate it, it'll be piecemeal"

"We also say that by regulating it, you're sending a signal to the marketplace to ... create healthier oils."

"We think we've given the government a great opportunity to implement what was a consensus report," she said. "[The food industry] supported all the recommendations, they're ready to act. Now we need the government to act."

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About Me

Family doc, Assistant Prof. at the University of Ottawa, Author of The Diet Fix, and founder of Ottawa's non-surgical Bariatric Medical Institute - a multi-disciplinary, ethical, evidence-based nutrition and weight management centre. Nowadays I'm more likely to stop drugs than start them. You can also find me on Twitter and Facebook.

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